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General NPI Number Information
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NPI Number | 1730638669
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Entity Type | Individual
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Provider Name | KATY MARCONETT
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Gender | Female
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 5954 LONGFORD RD
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-2998
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Country | US
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Telephone | 937-237-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 W ALEX BELL RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-1246
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Country | US
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Telephone | 937-681-1239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT011840
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License Number State |
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